Robert Kenneth Wadlin, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE 00006617 Issued in WA

Practice address

745 Maple Ave
#A
La Conner, WA 98257-0327

Phone

(360) 630-5377

NPI assigned

Jun 12, 2008

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 12, 2008.

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213228800000",
    "number": "1851551915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 MAPLE AVE",
            "address_2": "#A",
            "city": "LA CONNER",
            "state": "WA",
            "postal_code": "982570327",
            "telephone_number": "360-630-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 MAPLE AVE",
            "address_2": "#A",
            "city": "LA CONNER",
            "state": "WA",
            "postal_code": "982570327",
            "telephone_number": "360-630-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADLIN",
        "first_name": "ROBERT",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2008-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE  00006617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in La Conner, WA
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.